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Prevention of neural-tube defects with periconceptional folic acid, methylfolate, or multivitamins?
Ann Nutr Metab. 2011 Oct; 58(4):263-71.AN

Abstract

BACKGROUND/AIMS

To review the main results of intervention trials which showed the efficacy of periconceptional folic acid-containing multivitamin and folic acid supplementation in the prevention of neural-tube defects (NTD).

METHODS AND RESULTS

The main findings of 5 intervention trials are known: (i) the efficacy of a multivitamin containing 0.36 mg folic acid in a UK nonrandomized controlled trial resulted in an 83-91% reduction in NTD recurrence, while the results of the Hungarian (ii) randomized controlled trial and (iii) cohort-controlled trial using a multivitamin containing 0.8 mg folic acid showed 93 and 89% reductions in the first occurrence of NTD, respectively. On the other hand, (iv) another multicenter randomized controlled trial proved a 71% efficacy of 4 mg folic acid in the reduction of recurrent NTD, while (v) a public health-oriented Chinese-US trial showed a 41-79% reduction in the first occurrence of NTD depending on the incidence of NTD.

CONCLUSIONS

Translational application of these findings could result in a breakthrough in the primary prevention of NTD, but so far this is not widely applied in practice. The benefits and drawbacks of 4 main possible uses of periconceptional folic acid/multivitamin supplementation, i.e. (i) dietary intake, (ii) periconceptional supplementation, (iii) flour fortification, and (iv) the recent attempt for the use of combination of oral contraceptives with 6S-5-methytetrahydrofolate (methylfolate), are discussed. Obviously, prevention of NTD is much better than the frequent elective termination of pregnancies after prenatal diagnosis of NTD fetuses.

Authors+Show Affiliations

Foundation for the Community Control of Hereditary Diseases, Budapest, Hungary. czeizel@interware.huNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21865678

Citation

Czeizel, Andrew E., et al. "Prevention of Neural-tube Defects With Periconceptional Folic Acid, Methylfolate, or Multivitamins?" Annals of Nutrition & Metabolism, vol. 58, no. 4, 2011, pp. 263-71.
Czeizel AE, Dudás I, Paput L, et al. Prevention of neural-tube defects with periconceptional folic acid, methylfolate, or multivitamins? Ann Nutr Metab. 2011;58(4):263-71.
Czeizel, A. E., Dudás, I., Paput, L., & Bánhidy, F. (2011). Prevention of neural-tube defects with periconceptional folic acid, methylfolate, or multivitamins? Annals of Nutrition & Metabolism, 58(4), 263-71. https://doi.org/10.1159/000330776
Czeizel AE, et al. Prevention of Neural-tube Defects With Periconceptional Folic Acid, Methylfolate, or Multivitamins. Ann Nutr Metab. 2011;58(4):263-71. PubMed PMID: 21865678.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of neural-tube defects with periconceptional folic acid, methylfolate, or multivitamins? AU - Czeizel,Andrew E, AU - Dudás,István, AU - Paput,László, AU - Bánhidy,Ferenc, Y1 - 2011/08/25/ PY - 2011/05/30/received PY - 2011/07/08/accepted PY - 2011/8/26/entrez PY - 2011/8/26/pubmed PY - 2012/3/13/medline SP - 263 EP - 71 JF - Annals of nutrition & metabolism JO - Ann. Nutr. Metab. VL - 58 IS - 4 N2 - BACKGROUND/AIMS: To review the main results of intervention trials which showed the efficacy of periconceptional folic acid-containing multivitamin and folic acid supplementation in the prevention of neural-tube defects (NTD). METHODS AND RESULTS: The main findings of 5 intervention trials are known: (i) the efficacy of a multivitamin containing 0.36 mg folic acid in a UK nonrandomized controlled trial resulted in an 83-91% reduction in NTD recurrence, while the results of the Hungarian (ii) randomized controlled trial and (iii) cohort-controlled trial using a multivitamin containing 0.8 mg folic acid showed 93 and 89% reductions in the first occurrence of NTD, respectively. On the other hand, (iv) another multicenter randomized controlled trial proved a 71% efficacy of 4 mg folic acid in the reduction of recurrent NTD, while (v) a public health-oriented Chinese-US trial showed a 41-79% reduction in the first occurrence of NTD depending on the incidence of NTD. CONCLUSIONS: Translational application of these findings could result in a breakthrough in the primary prevention of NTD, but so far this is not widely applied in practice. The benefits and drawbacks of 4 main possible uses of periconceptional folic acid/multivitamin supplementation, i.e. (i) dietary intake, (ii) periconceptional supplementation, (iii) flour fortification, and (iv) the recent attempt for the use of combination of oral contraceptives with 6S-5-methytetrahydrofolate (methylfolate), are discussed. Obviously, prevention of NTD is much better than the frequent elective termination of pregnancies after prenatal diagnosis of NTD fetuses. SN - 1421-9697 UR - https://www.unboundmedicine.com/medline/citation/21865678/Prevention_of_neural_tube_defects_with_periconceptional_folic_acid_methylfolate_or_multivitamins L2 - https://www.karger.com?DOI=10.1159/000330776 DB - PRIME DP - Unbound Medicine ER -